1,720,962 research outputs found
Routine near infra-red indocyanine green fluorescent cholangiography versus intraoperative cholangiography during laparoscopic cholecystectomy. A case-matched comparison
No full textBACKGROUND:
The aim is to evaluate safety and efficacy of near infra-red (NIR) indocyanine green (ICG) fluorescence structural imaging during laparoscopic cholecystectomy (LC) (Group A) and to compare perioperative data, including operative time, with a series of patients who underwent LC with routine traditional intraoperative cholangiography (IOC) (Group B).
METHODS:
Forty-four patients with acute or chronic cholecystitis underwent NIR-ICG fluorescent cholangiography during LC. ICG was administered intravenously at different time intervals or by direct gallbladder injection during surgery. Fluorescence intensity and anatomy identification were scored according to a visual analogue scale between 1 (least accurate) and 5 (most accurate). Group B patients (n = 44) were chosen from a prospectively maintained database of patients who underwent LC with routine IOC, matched for age, sex, body mass index, and diagnosis with group A patients.
RESULTS:
No adverse reactions were recorded. In group A, mean time between intravenous administration of ICG and surgery was 10.7 ± 8.2 (range 2-52) h. Administered doses ranged from 3.5 to 13.5 mg. Fluorescence was present in all cases, scoring ≥ 3 in 41 patients. Mean operative time was 86.9 ± 36.9 (30-180) min in group A and 117.9 ± 43.4 (40-220) min in group B (p = 0.0006). No conversion to open surgery nor bile duct injuries were observed in either group.
CONCLUSIONS:
LC with NIR-ICG fluorescent cholangiography is safe and effective for early recognition of anatomical landmarks, reducing operative time as compared to LC with IOC, even when residents were the main operator. NIR-ICG fluorescent cholangiography was effective in patients with acute cholecystitis and in the obese. Data collection into large registries on the results of NIR-ICG fluorescent cholangiography during LC should be encouraged to establish whether this technique might set a new safety standard for LC
Comparison of two questionnaires on informed consent in "marginal" donor liver
No full textThe necessity of liver donors has contributed to overcome the traditional criteria and to propose new ones for the acceptance of livers for transplantation. For this reason expanded or extended donation criteria (ECD) or even overextended criteria for marginal or high risk organ donors have been developed. ELPAT end ELITA-ELTR coordinated the distribution of questionnaire previously reported, that was sent to 53 European liver transplant centers. Criteria were divided based on the response rate. Criteria as Steatosis and Serum sodium > 165 mmol/L in more than 60% of cases are not considered a contraindication to transplantation as well as a previous history of cancer. Criteria as ICU stay, BMI > 30, Serum bilirubin > 3 mg/dL and HIV+ or critically illness are not considered adequate for transplantation from 30% to 59% of cases. On the other hand there is no agreement on other Extended liver donor and recipients criteria such as age up to 80 years, SGOT > 90 U/L, SGPT > 105 U/L and high risk sex practices, drug users, only age > 65 and only age < 65, respectively. Criteria as serum sodium could be not considered ECD criteria. In conclusion the development of more studies as well as the inclusion of more world-wide liver transplantation centers are required to confirm these data
Ex vivo Sentinel Lymph Node Mapping in Colorectal Cancer Using Invisible Near-Infrared Fluorescence Light
No full textEffects of Laparoscopic Sleeve Gastrectomy on Quality of Life Related to Gastroesophageal Reflux Disease
No full textPurpose: Effects of laparoscopic sleeve gastrectomy (LSG) on gastroesophageal reflux disease (GERD) symptoms are controversial. Our aim is to evaluate the effects of LSG on GERD symptoms in obese patients using a validated quality-of-life questionnaire. Methods: Records of 100 patients (median body mass index [BMI] 44.4 kg/m2, range 35-63.6) without hiatal hernia or severe GERD were analyzed. GERD symptoms were evaluated by GERD Health-Related Quality-of-Life (HRQL) questionnaire before and after surgery. Weight loss and comorbidity resolution were recorded. Results: Median GERD-HRQL scores decreased from 7 (range 0-44) to 3 (0-34) (P = .025) (median follow-up 56 months [range 7-136]). GERD-HRQL scores improved in 55 patients and worsened in 21; de novo GERD was observed in 10; no change occurred in 14 patients (differences being statistically significant: P = <.0001). On multilinear regression analysis, total preoperative GERD-HRQL score and postoperative BMI were independent variables for overall postoperative GERD-HRQL score: higher total preoperative GERD-HRQL score was associated with improved postoperative GERD-HRQL scores, whereas higher postoperative BMI was associated with worse total postoperative GERD-HRQL score. Resolution of diabetes, hypertension, and sleep apnea syndrome occurred in 84.4%, 68%, and 89.7% of patients, respectively. Conclusions: In obese patients, although LSG was associated with statistically significantly improved postoperative GERD-HRQL scores at mid-term follow-up in 55% of patients, only preoperative GERD-HRQL score and postoperative BMI were independent predictors of GERD after LSG. Higher overall preoperative GERD-HRQL score was associated with improved postoperative GERD-HRQL score. However, further research is needed to assess how to predict GERD outcome
A Rare Case of Colorectal Complete Anastomotic Stenosis Treated by TEM
No full textAims: Since the introduction of Natural Orifice Transluminal Endoscopic Surgery
(NOTES) in 2004, it has attracted a great deal of interest from surgeons. Transanal
Endoscopic Microsurgery (TEM) is a type of NOTES, developed by Buess for rectal
tumors, and utilized also to treat other rectal diseases.
We achieved a wide experience utilizing TEM to treat rectal disorders such as recto-vaginal
fistula, recto-vesical fistula, GIST, etc.
We describe a rare postoperative complication solved by transanal approach by TEM.
This is an original contribution because after a revision of the literature no other similar
cases were described
Methods: We present the case of a 36 year-old woman who presented with intermittent
abdominal distention, pain and constipation. After Hirschprung Disease was diagnosed, the
patient was submitted to a modified Duhamel operation and ileostomy.
A postoperative barium enema control showed a complete stricture of the anastomosis.
It was impossible to resolve the stricture by flexible endoscopic approach, because no
orifice could be detected by the endoscopist.
Then an intraoperative endoscopic approach to facilitate the localization of pre-anastomotic
colon was performed by a small colotomy and the colonic recanalization was obtained by
the creation of a neo-anastomosis by TEM.
Results: The patient underwent a control barium enema on 30th POD, showing regular
retrograde transit of contrast medium without evidence of stenosis. She underwent a surgical
operation for the closure of the ileostomy with regular restoration of intestinal
canalization.
Conclusions: Transanal approach by TEM is safe and feasible and represents a model of
NOTES which can be applied even to a wide range of applications
Recto-urinary fistula (RUF) treated by transanal endoscopic microsurgery (TEM). Review of the literature and surgical technique
No full textIntroduction. Acquired Rectourinary Fistula is often caused by major surgery. Different techniques and approaches are reported but there is no definitive treatment: Transanal Endoscopic Microsurgery allows to operate with a magnified and tridimensional vision and offers the advantage of being less invasive.
Materials and Methods
Discussion. The ideal treatment should ensure correct hemostastis and provide for carring out the sutures on healthy tissue with adequate vascularization, less inflamed tissue and a tension free suture line. The minimally invasive approach should be pursued with the goal of reducing morbidity and mortality; from 1983 to now 17 cases of TEM-assisted fistulas treatment are reported in literature with only four recurrences. TEM gives great results even in patients who have already undergone previous surgical attempts.
Conlusions. TEM-assisted procedure is an alternative to traditional methods and offers the advantages of operating in a three-dimensional field, with fewer blood loss and less complications; unfortunately, in the treatment of patients irradiated shares with other approaches to the same problems and the same results
Hiatoplasty with Crura Buttressing versus Hiatoplasty Alone during Laparoscopic Sleeve Gastrectomy
Full text linkIntroduction. In obese patients with hiatal hernia (HH), laparoscopic sleeve gastrectomy (LSG) with cruroplasty is an option but use of prosthetic mesh crura reinforcement is debated. The aim was to compare the results of hiatal closure with or without mesh buttressing during LSG. Methods. Gastroesophageal reflux disease (GERD) was assessed by the Health-Related Quality of Life (GERD-HRQL) questionnaire before and after surgery in two consecutive series of patients with esophageal hiatus ≤ 4 cm2. After LSG, patients in group A (12) underwent simple cruroplasty, whereas in group B patients (17), absorbable mesh crura buttressing was added. Results. At mean follow-up of 33.2 and 18.1 months for groups A and B, respectively (p=0.006), the mean preoperative GERD-HRQL scores of 16.5 and 17.7 (p=0.837) postoperatively became 9.5 and 2.4 (p=0.071). In group A, there was no difference between pre- and postoperative scores (p=0.279), whereas in group B, a highly significant difference was observed (p=0.002). The difference (Δ) comparing pre- and postoperative mean scores between the two groups was significantly in favor of mesh placement (p=0.0058). Conclusions. In obese patients with HH and mild-moderate GERD, reflux symptoms are significantly improved at medium term follow-up after cruroplasty with versus without crura buttressing during LSG
Laparoscopic sleeve gastrectomy changes in the last decade. Differences in morbidity and weight loss
No full textPURPOSE:
Aim is to report the learning curve and standardization process of Laparoscopic Sleeve Gastrectomy (LSG), describing the evolution in surgical technique and patient management in the authors' experiences.
METHODS:
One hundred twenty-seven patients were divided in three Groups (A, B, and C), based on bougie size and technical details, and included 36, 46, and 45 patients, respectively.
RESULTS:
Mean operative time in Groups A, B, and C was 201.5, 150.8, and 172 minutes, respectively. Conversion to open surgery occurred in 1 Group A case. Eleven postoperative complications (8.6%) were observed (1 Group A, 8 Group B, 2 and Group C). Mean hospital stay in Groups A, B, and C, was 7.1, 6.9, and 3.1 days, respectively. At a mean follow-up of 69.7 months (Group A), 33.3 months (Group B), and 14.8 months (Group C), mean postoperative body mass index is 32.6, 28.1, and 31.5 kg/m2, respectively. Percentage estimated body mass index loss (%EBMIL) was 74.8% for Group A, 85.7% for Group B, and 68.1% for Group C.
CONCLUSIONS:
LSG is a safe and effective procedure. In the postoperative course, meticulous alertness to early warning signs of sepsis and aggressive patient management are mandatory to prevent mortality. The use of a larger bougie size was associated with weight regain.PURPOSE:
Aim is to report the learning curve and standardization process of Laparoscopic Sleeve Gastrectomy (LSG), describing the evolution in surgical technique and patient management in the authors' experiences.
METHODS:
One hundred twenty-seven patients were divided in three Groups (A, B, and C), based on bougie size and technical details, and included 36, 46, and 45 patients, respectively.
RESULTS:
Mean operative time in Groups A, B, and C was 201.5, 150.8, and 172 minutes, respectively. Conversion to open surgery occurred in 1 Group A case. Eleven postoperative complications (8.6%) were observed (1 Group A, 8 Group B, 2 and Group C). Mean hospital stay in Groups A, B, and C, was 7.1, 6.9, and 3.1 days, respectively. At a mean follow-up of 69.7 months (Group A), 33.3 months (Group B), and 14.8 months (Group C), mean postoperative body mass index is 32.6, 28.1, and 31.5 kg/m2, respectively. Percentage estimated body mass index loss (%EBMIL) was 74.8% for Group A, 85.7% for Group B, and 68.1% for Group C.
CONCLUSIONS:
LSG is a safe and effective procedure. In the postoperative course, meticulous alertness to early warning signs of sepsis and aggressive patient management are mandatory to prevent mortality. The use of a larger bougie size was associated with weight regain
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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